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PayQuiq Invoice

Please review the charges below, contact Danielle Harris at dharris@payquiq.com with any questions.

If you are ordering mobile card swipe device(s) please fill out the fields in the form below regarding requested date to order and address/contact name devices are being sent to.

Please allow a week for shipping
If renting specify what month(s) of rental

Rented Devices

Yes

Max amount charged: $35/device

Account Details

Enter your name and e-mail address for your confirmation:

Payment Information

  

Total:   

For added Security please check the box below.